Updated NICE guidance on antimicrobial prescribing in Clostridium difficile infection was published in July 2021
These options are not presented in any order of preference neither are they exhaustive.
The preferred choice is dependent on the patient and the care setting. Key issues together with their risks and mitigations where appropriate are discussed for each option.
Check the patient can swallow tablets.
If patients are unable to swallow tablets, this can lead to omission or delay, or a choking risk.
Crushing licensed tablets
Both these methods of administration are unlicensed.
For patients with swallowing difficulties, the tablets can be crushed and mixed with water or apple sauce for administration.
Ongoing advice regarding crushing or mixing tablets depends on the food and fluid the patient is able to swallow safely.
Patients who cannot safely swallow will need to be assessed by a Speech and Language therapist and the swallow assessment report, together with this SPS advice on swallowing difficulties, may be helpful in these situations.
Enteral feeding tubes
In patients with an enteral feeding tube the tablets may be crushed and mixed with water.
Swallowing difficulties: the patient may not receive the full dose.
Enteral feeding tubes: the tube may become blocked.
Ensure the patient receives all of the water or apple sauce in which the dose has been mixed.
Enteral feeding tubes
There is limited data for use via enteral feeding tubes and so this is not recommended unless there are no other options. The tablets are film-coated, so crush well to avoid tube blockage, and flush well after administration to ensure that the entire dose has been given.
Licensed granules for oral suspension
The granules have a UK marketing authorisation and are expected to be available from wholesalers in the latter half of 2022.
Granules for oral suspension (40 mg/ml) may be used in patients with difficulties in swallowing tablets depending on the food and fluid the patient is able to swallow safely, as above. Fidaxomicin does not interact with food so administration with food of the appropriate texture would be the preferred option for people who need thickened fluids. Thickening the suspension would not be recommended as it is not possible to assess you have thickened to the appropriate level.
Delayed and omitted doses as a result of stock unavailability in UK wholesalers.
Use an alternative formulation or choice of therapy as clinically appropriate until the supply chain is stable.
Oral treatment options for Clostridium difficile
- Updated to reflect UK stock unavailability of granules until Q2 2022
- Updated to include reference to 'safe swallow' and further link to SPS advice.